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Yr 5 Respiratory > Asthma & COPD > Flashcards

Asthma & COPD Flashcards

1
Q

What is asthma?

A

Reversible small airway obstruction due to bronchial hypersensitivity
Characterised by bronchospasm + inflammation + oedema

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2
Q

What are the precipitants of asthma?

A 
Cold air
Smoking
Exercise
Damp
Allergens
Drugs (Aspirin, NSAIDs, BB)
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3
Q

How does asthma present?

A 
Nocturnal cough
Recurrent rhinitis
Exertional dyspnoea 
Reflux
Diurnal variation
Sx of atopy
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4
Q

How does an acute asthma attack present?

A 
Acute dyspnoea
Hyperinflated chest
Polyphonic wheeze
↑Mucous production 
↑HR + ↑RR (hyperventilation) 
↑Resonance on Percussion
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5
Q

How is asthma investigated?

A

PEFR
Spirometry
Fractional exhaled NO test (>17yo)
Histamine/Methacholine direct bronchial challenge test

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6
Q

How is asthma diagnosed?

A 
Sx PLUS:
-FeNO >40 
OR
-FEV1/FVC <70%
OR
-FeNO 25-30 AND +ve bronchodilator reversibility test
OR
- +ve bronchodilator reversibility test >200ml or 12%
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7
Q

How is spirometry used when investigating asthma?

A

FEV1/FVC <70% (<0.7)

Do bronchodilator reversibility test (give SABA)

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8
Q

How is PEFR used when investigating asthma?

A

If uncertain ∆ post-FeNO/Spirometry/Reversibility
Monitor peak flow for 2-4w
Compare w/predicted peak flow
Monitor for diurnal variation

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9
Q

How is asthma managed in an adult?

A

1) SABA (Salbutamol)
2) SABA + ICS (Beclamethasone BD)
3) SABA + ICS + LRTA (Montelukast) review in 4-8w
4) SABA + ICS + LABA (Salmeterol)- Stop LRTA
5) SABA + MART (ICS + LABA Combi inhaler) ± LTRA- Stop LABA
6) ↑Dose to mod ICS
7) ↑Dose to high ICS OR trial LAMA/Theophylline/Specialist

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10
Q

In managing asthma when should moving up the ‘ladder’ be considered?

A

Using salbutamol >3 doses/week

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11
Q

How is acute asthma treated?

A

OH SHIT ME!

O: O2 if <94%
S: Salbutamol news 5mg back to back every 20mins x3 doses
H: Hydrocortisone IV 100mg
I: Ipratropium nebs 500mcg 4-6hourly
T: Theophylline IV
M: 2g MgSO4 in 100mls NaCl IV over 20mins
E: Erm HELP!!- CPAP

O2 driven nebs- 6L
Give 1-4 at the same time

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12
Q

What bronchodilator reversibility levels would suggest someone has asthma?

A

A 200ml improvement in FEV1 or 12% in response to:

  • 400mcg salbutamol
  • 6w trial of ICS (beclometasone 200mcg bd)
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13
Q

How much salbutamol should be advised to give to a patient having an asthma attack (where nebs can’t yet be given)?

A

4 puffs of salbutamol
then
2puffs every 2 mins-max 10 puffs

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14
Q

When someone is sent home post-asthma attack what meds need to be given?

A

If PEFR <50% initially: Prednisolone 40mg 5days
Can be stopped abruptly if continuing ICS
Salbutamol weaning: 6 puffs QDS, 4 puffs QDS

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15
Q 
What are the differences in:
FEV1
FVC
FEV1/FVC
in obstructive &amp; restrictive lung diseases?
A

O: ↓FVC, ↓↓FEV1, ↓FEV1/FVC
R: ↓↓FVC, ↓FEV1, ↑FEV1/FVC

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16
Q

What are the common obstructive lung diseases?

A

Asthma
COPD
Bronchiectasis
Bronchiolitis obliterans

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17
Q

What are the common restrictive lung diseases?

A 
Pulmonary fibrosis
Asbestosis
Sarcoidosis
NM disorders
ARDS
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18
Q

In an asthma attack, what constitutes a moderate attack?

A

↑Sx

PEFR 50-70%

19
Q

In an asthma attack, what constitutes a severe attack?

A

PEFR 33-50%
Inability to complete sentences
↑RR ≥ 25
↑HR >110

20
Q

In an asthma attack, what constitutes a life threatening attack?

A 
PEFR <33%
SpO2 <92%
PaO2 <8
Normal PaCO2
Cyanosis
HypoT
Silent chest
Confusion/exhaustion
Arrhythmia
21
Q

In an asthma attack, what constitutes a near fatal attack?

A

PaCO2 >6- requires mechanical ventilation

22
Q

What is COPD?

A

Progressive, irreversible, obstructive airway disease

2types: Chronic bronchitis, Emphysema

23
Q

How are chronic bronchitis and emphysema differentiated?

A

CB: Cough >3m for 2 consecutive years, ↓alveolar ventilation + undamaged capillary bed → ↑residual lung volume + hypoventilate (→ T2 RF +cyanosis)
E: Enlarged alveolar airspace, ↑alveolar ventilation + damaged capillary bed → muscle waste + hyperventilate (→ T1 RF)

24
Q

What are the 2 types and causes of emphysema?

A

Centrilobular: Smoking
Panlobular: α1-Antitrypsin deficient due to Cirrhosis

25
Q

Which type of COPD relies on the hypoxic drive for respiratory effort?

A

Chronic bronchitis patients

26
Q

Who should be worked up for ?COPD?

A

> 35yo current or ex-smoker w/chronic cough

27
Q

What are the signs of COPD on spirometry?

A 
FVC <0.7
FEV1/FVC <70%
FEV1 varies
TLC↑  
RV↑
28
Q

What are the different stages of COPD?

A

Mild/S1: FEV1 >80%, FVC <0.7 post-bronch
Mod/S2: FEV1 50-79%, FVC <0.7
Severe/S3: FEV1 30-49%, FVC <0.7
V.Severe/S4: FEV1 <30%, FVC <0.7

29
Q

When in COPD is spirometry CI?

A

Recent MI/Stroke/Surgery
Unstable angina
Pneumothorax
TB

30
Q

What investigations should be done when initially diagnosing COPD?

A

Spirometry
CXR
FBC ↑PCV (assess polycythaemia)
BMI (work out BODE Index)

31
Q

What is the BODE Index?

A 
4yr Survival predictor
B: BMI (>21/ <21)
O: Obstruction (FEV1 post-bronch)
D: Dyspnoea scale
E: Exercise capacity (6min walk)

0 to 2 Points: 80%
3 to 4 Points: 67%
5 to 6 Points: 57%
7 to 10 Points: 18%

32
Q

What will be seen on an ABG of someone with emphysema & chronic bronchitis?

A

E: ↓PaO2
CB: ↓PaO2 ↑PaCO2

33
Q

How is stable COPD managed?

A

1) SABA (Salbutamol)/ SAMA (Ipratropium)
2) FEV1 >50% = LABA (Salmeterol)/ LAMA (Tiotropium)
2) FEV1 <50% = LABA + ICS (Beclomethasone/Fostair) OR LAMA ALONE
3) LABA + ICS + LAMA
4) Theophylline + Salbutamol

Productive cough: Mucolytic (Carbocristine)

34
Q

What are the indications for BiPAP?

A 
pH <7.3
PCO2 >6
Resp weakness
Chest wall deformity
Obesity
Hypoventilation
35
Q

What is the criteria for LTOT in COPD?

A

pH <7.3 when stable AND one of:

  • Polycythaemia
  • Nocturnal hypoxaemia sats <90%
  • Peripheral oedema
  • Pulmonary HTN
36
Q

What are the signs of COPD on CXR?

A 
Hyperexpanded- >6 ant ribs
Large central pulmonary arteries
Bullae
Peripheral vascular markings
Flattened hemi-diaphragm
37
Q

Other than medications, in COPD what other treatments are available?

A

Vaccines: Annual flu & Pneumococcal (↑↑ risk of Hib)

Pulmonary rehab

38
Q

How is an acute exacerbation of COPD managed?

A

COSI CAR:
CO: Controlled O2- 28% venturi
S: Salbutamol 5mg nebs w/O2 OR air
I: Ipratropium 500mcg
C: CXR- ALL & Corticosteroids IV hydrocortisone 200mg
A: IV Abx if from infection (Clarith or Doxy)
R: Resp support- BiPAP if CO2 rising

39
Q

When someone is sent home post-COPD exacerbation what meds need to be given?

A

Prednisolone 30mg 7d

Abx: IF Hx of fever/purulent sputum = Amoxicillin

40
Q

How can individuals feeling unwell with COPD avoid hospital?

A

Use rescue packs:
↑ Salbutamol use to control Sx
PO Steroids
Abx if purulent sputum

41
Q

What are the complications of COPD?

A

Cor Pulmonale

Over-oxygenation

42
Q

How does Cor Pulmonale occur?

A

COPD destroys cap bed
Leads to ↑pulm pressure + hypoxia = reflex pulmonary vasoC + ↑vasc resistance
↑Pul pressure past threshold → R ventricular failure = HF

43
Q

How does Cor Pulmonale present?

A 
Bronchiectasis
Peripheral oedema
Dyspnoea
Nausea
↑ JVP
44
Q

How is O2 titrated in COPD exacerbations?

A

CRITICALLY ILL: 15L/min reservoir mask
SERIOUSLY ILL: 2-6L/min via nasal cannula or 5-10L/min via mask, Sats <85% = 15L reservoir
MILD: 28% venturi recheck ABG at 30-60mins titre up if needed

Yr 5 Respiratory (6 decks)

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